Individual
MR. MATTHEW THOMAS BEALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
137 PORTLAND ST, 4TH FLOOR, BOSTON, MA 02114
(617) 996-9058
Mailing address
1084 N EL CAMINO REAL STE B, #122, ENCINITAS, CA 92024
(925) 407-6904
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPO03996
AMERICAN BOARD FOR CERTIFICATION (ORTHOTICS, PROSTHETICS, PEDORTHICS
—
01
—
OI61292553
WASHINGTON STATE DEPARTMENT OF HEALTH ORTHOTIST LICENSE
WA
01
—
PS61292556
WASHINGTON STATE DEPARTMENT OF HEALTH PROSTHETIST LICENSE
WA
Enumeration date
05/10/2018
Last updated
08/30/2022
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